Visceral adiposity is associated with chronic diseases. This cross-sectional analysis examined the association between diet quality (Healthy Eating Index-2010 (HEI-2010) scores) and DXA-based visceral adipose tissue (VAT), overall adiposity, blood-based biomarkers of metabolic risk, and visual representation (VR) of body shape.


540 adults (18-80 yr; white, Black, Asian, Latino, Native Hawaiian or Other Pacific Islander) were recruited across 3 sites (Honolulu, San Francisco, and Baton Rouge) for the Shape Up! Adults study. Whole-body DXA, anthropometry, fasting blood draw, questionnaires (food frequency, physical activity, characteristics), and 3D optical images were completed. Linear models were used to assess the association between HEI-2010 tertiles and VAT, overall adiposity, and blood-based biomarkers. Analyses included all participants and stratified by age (18<40, 40<60, 60<80 yr). PCA derived principle components described the variance of body shape in both men and women. Manifold regression provided VR of body shape for comparison of body shape with the highest and lowest HEI-2010 scores. Models were adjusted for known confounders.


Among participants 40<60 yr with the highest diet quality scores, VAT/SAT (subcutaneous adipose tissue) was significantly lower (p<0.008). Higher diet quality was inversely related to VAT for the whole study sample (p<0.001) and for participants 60<80 yr (p<0.006). Higher diet quality was also inversely related to body mass index, % body fat, total body fat, trunk fat, HbA1c, insulin, HOMA-IR, and glucose (p<0.05). For both men and women with the highest HEI-2010 scores, the VR showed lower abdominal adiposity compared to the lowest scores.


Following a higher quality diet is associated with lower VAT, overall obesity, and blood-based metabolic risk biomarkers. A higher quality diet may help to preferentially promote storage of SAT vs. VAT in adults 40<60 yr and minimize VAT accumulation in adults 60<80 yr.